The field has rapidly evolved over the past decade due to new evidence regarding the management of cardiovascular implantable electronic devices (CIEDs) and the rapid growth of new CIED technologies. New “2026 HRS/AHA/APHRS/EHRA/IDSA/LAHRS/PACES/STS Expert Consensus Statement Update on Cardiovascular Implantable Electronic Device Lead Management and Extraction” heart rhythmis the official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society, and the Pediatric and Congenital Electrophysiology Society, published by Elsevier, and details the latest recommendations to help clinicians and patients select the right devices and manage them over time to reduce complications and support a better quality of life.
Over the past 70 years, CIED has been established as a treatment option for some patients with bradycardia, tachycardia, and heart failure. It is estimated that 800,000 CIEDs will be implanted in the United States in 2022. Due to the aging of the global population, future CIED implant rates are expected to be even higher, especially for permanent pacemakers.
CIEDs have traditionally used leads that connect the pulse generator to the heart tissue. Since the publication of the 2017 HRS Expert Consensus Statement on Cardiovascular Implantable Electronics Lead Management and Extraction, the field has rapidly evolved with the publication of new evidence on CIED transvenous lead management, the development of new CIED techniques using leads that are leadless or implanted outside the vasculature, widespread adoption of lumenless leads, new lead extraction tools, and new cardiac and vascular procedures with leads. Management implications.
A holistic approach to CIED selection and use is needed and, in turn, the potential lead management impact over the patient’s lifetime must be considered. The document we are presenting today is intended to assist clinicians in the decision-making process for managing considerations regarding lead and CIED implants and updates the 2017 expert consensus statement. ”
Yong-Mei Cha, MD, FHRS, Mayo Clinic in Rochester, writing committee chair
The consensus statement writing committee is comprised of internationally recognized experts from five countries representing multiple professional societies in the fields of clinical electrophysiology, pediatric electrophysiology, cardiothoracic anesthesiology, cardiothoracic surgery, and infectious diseases. They systematically reviewed scientific evidence and translated their findings into recommendations to improve quality of care in CIED lead management. This current expert consensus statement focuses on providing an update on practical clinical guidance in the broad area of lead management, including extraction and management of conventional CIEDs using transvenous leads, CIEDs with extravascular or subcutaneous leads, and leadless CIEDs.
The new recommendations address modern CIED technology superior to transvenous leads, new evidence supporting the diagnosis, treatment, and prevention of CIED infections, appropriate lead management during transcatheter tricuspid valve replacement for tricuspid regurgitation, and standardization of transvenous lead removal approaches, protocols, and equipment to improve CIED lead management and removal outcomes.
“New technologies in CIED offer the potential to reduce the clinical challenges and morbidity associated with endovascular devices. Since the 2017 Consensus Statement, the use of leadless pacing and nonvascular implantable cardioverter defibrillators has increased significantly, ushering in a new paradigm for nonvascular cardiac rhythm management,” said Dr. Cha.
“Future lead management must be considered when implanting a CIED containing a leadless pacemaker.Device selection and lead management issues include clinical indication, patient comorbidities, anticipated patient These include longevity, lead performance, the impact of future CIED complications, and potential clinical benefits and risks. This collaborative approach ensures that device and lead selection and management strategies are aligned to optimize long-term outcomes, taking into account the patient’s long-term health, personal preferences, and quality of life. ”
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Reference magazines:
Mr. Cha, Mr. Y.-M. others. (2026). 2026 HRS/AHA/APHRS/EHRA/IDSA/LAHRS/PACES/STS Update to Expert Consensus Statement for Cardiovascular Implantable Electronic Device Lead Management and Extraction. heart rhythm. DOI: 10.1016/j.hrthm.2026.04.015. https://www.heartrhythmjournal.com/article/S1547-5271(26)02264-2/pdf
